ArticlePloS one2020
Estimating the impact of differential adherence on the comparative effectiveness of stool-based colorectal cancer screening using the CRC-AIM microsimulation model.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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Who cites it
20 citing papers in PubMed, 26 citations in OpenAlex.
- Cost-Effectiveness of Colonoscopy for Screening: What Matters Most?Gut and liver · 2026Article
- Comparison of Benefit-to-Burden Ratios for Stool-Based Colorectal Cancer Screening Tests in the U.S.: A Decision Analytical Modeling Approach.AJPM focus · 2026Article
- Optimizing Colonoscopy Capacity to Maximize Colorectal Cancer Outcomes.Gastro hep advances · 2026Article
- Evaluating benefit-to-burden ratios of the established and emerging colorectal cancer screening strategies.Journal of the National Cancer Institute · 2025Article
- Challenges and proposed solutions to the adoption of cell free DNA in screening, detecting and prognosticating colorectal cancer.World journal of gastrointestinal oncology · 2025Review
- Prognostic Significance of the Comprehensive Biomarker Analysis in Colorectal Cancer.Life (Basel, Switzerland) · 2025Review
- Impact of Eliminating Cost-Sharing by Medicare Beneficiaries for Follow-Up Colonoscopy After a Positive Stool-based Colorectal Cancer Screening Test.Cancer research communications · 2023Article
- Comparison of Simulated Outcomes Between Stool- and Blood-Based Colorectal Cancer Screening Tests.Population health management · 2023Article
- Inappropriate Multi-Target Stool DNA Use for Colorectal Cancer Screening: Risks, Compliance, and Outcomes.Cureus · 2023Article
- Review
- Impact of race-specific screening guideline on the uptake of colorectal cancer screening among young African Americans.Cancer medicine · 2022Article
- Cost-Effectiveness of Waiving Coinsurance for Follow-Up Colonoscopy after a Positive Stool-Based Colorectal Screening Test in a Medicare Population.Cancer prevention research (Philadelphia, Pa.) · 2022Article
- Circulating cell-free DNA for cancer early detection.Innovation (Cambridge (Mass.)) · 2022Review
- Optimal Strategies for Colorectal Cancer Screening.Current treatment options in oncology · 2022Review
- Life-years gained resulting from screening colonoscopy compared with follow-up colonoscopy after a positive stool-based colorectal screening test.Preventive medicine reports · 2022Article
- Impact of the Sessile Serrated Polyp Pathway on Predicted Colorectal Cancer Outcomes.Gastro hep advances · 2022Article
- Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a large, nationally insured cohort.International journal of colorectal disease · 2021Article
- Impact of Patient Adherence to Stool-Based Colorectal Cancer Screening and Colonoscopy Following a Positive Test on Clinical Outcomes.Cancer prevention research (Philadelphia, Pa.) · 2021Article
- Detection of Postcolonoscopy Colorectal Neoplasia by Multi-target Stool DNA.Clinical and translational gastroenterology · 2021Article
- Impact of screening and follow-up colonoscopy adenoma sensitivity on colorectal cancer screening outcomes in the CRC-AIM microsimulation model.Cancer medicine · 2021Article
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundReal-world adherence to colorectal cancer (CRC) screening strategies is imperfect. The CRC-AIM microsimulation model was used to estimate the impact of imperfect adherence on the relative benefits and burdens of guideline-endorsed, stool-based screening strategies.
methodsPredicted outcomes of multi-target stool DNA (mt-sDNA), fecal immunochemical tests (FIT), and high-sensitivity guaiac-based fecal occult blood tests (HSgFOBT) were simulated for 40-year-olds free of diagnosed CRC. For robustness, imperfect adherence was incorporated in multiple ways and with extensive sensitivity analysis. Analysis 1 assumed adherence from 0%-100%, in 10% increments. Analysis 2 longitudinally applied real-world first-round differential adherence rates (base-case imperfect rates = 40% annual FIT vs 34% annual HSgFOBT vs 70% triennial mt-sDNA). Analysis 3 randomly assigned individuals to receive 1, 5, or 9 lifetime (9 = 100% adherence) mt-sDNA tests and 1, 5, or 9 to 26 (26 = 100% adherence) FIT tests. Outcomes are reported per 1000 individuals compared with no screening.
resultsEach screening strategy decreased CRC incidence and mortality versus no screening. In individuals screened between ages 50-75 and adherence ranging from 10%a-100%, the life-years gained (LYG) for triennial mt-sDNA ranged from 133.1-300.0, for annual FIT from 96.3-318.1, and for annual HSgFOBT from 99.8-320.6. At base-case imperfect adherence rates, mt-sDNA resulted in 19.1% more LYG versus FIT, 25.4% more LYG versus HSgFOBT, and generally had preferable efficiency ratios while offering the most LYG. Completion of at least 21 FIT tests is needed to reach approximately the same LYG achieved with 9 mt-sDNA tests.
conclusionsAdherence assumptions affect the conclusions of CRC screening microsimulations that are used to inform CRC screening guidelines. LYG from FIT and HSgFOBT are more sensitive to changes in adherence assumptions than mt-sDNA because they require more tests be completed for equivalent benefit. At imperfect adherence rates, mt-sDNA provides more LYG than FIT or HSgFOBT at an acceptable tradeoff in screening burden.
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